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Receipt of psychological counseling and integrative medicine services among breast cancer survivors with anxiety

  • Preclinical study
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Abstract

Purpose

To define the prevalence and risk factors of anxiety and examine rates and predictors of psychotherapy and integrative medicine service use in breast cancer survivors on aromatase inhibitors (AIs).

Methods

Observational study of patients with histologically confirmed stage 0–III hormone receptor-positive breast cancer taking a third-generation AI at the time of enrollment. Patients completed self-report measures of anxiety and utilization of psychotherapy and integrative medicine services at a single time-point. We used multivariate logistic regression analyses to identify factors associated with anxiety and receipt of anxiety treatment services.

Results

Among the 1085 participants, the majority were younger than 65 years of age (n = 673, 62.0%) and white (n = 899, 82.9%). Approximately one-third (30.8%) reported elevated anxiety (≥ 8 on the anxiety subscale of the Hospital Anxiety and Depression Scale). Of patients with elevated anxiety, only 24.6% reported receiving psychological counseling, 25.3% used integrative medicine services, and 39.8% received either type of treatment since their diagnosis. Patients with an education level of high school or less were less likely to receive psychological counseling (AOR, 0.43, 95% CI 0.19–0.95) and integrative medicine services (OR 0.30, 95% CI 0.12–0.72) than patients with higher levels of education.

Conclusions

Anxiety is common in breast cancer patients treated with AIs yet the majority of anxious patients do not receive evidence-based treatment, even when these treatments are available. Better systematic anxiety screening and treatment initiation are needed to reduce disparities in care by education level.

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References

  1. Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M et al (eds) (2018) SEER cancer statistics review, 1975–2016, National Cancer Institute. Based on November 2017 SEER data submission, posted to the SEER web site, April 2018

  2. Surveillance, Epidemiology, and End Results (SEER) Program (http://www.seer.cancer.gov) Research data (1975–2016), National Cancer Institute, DCCPS. Surveillance research program, released April 2019, based on the November 2018 submission

  3. Burstein HJ, Lacchetti C, Anderson H, Buchholz TA, Davidson NE, Gelmon KA, Giordano SH, Hudis CA, Solky AJ, Stearns V, Winer EP, Griggs JJ (2019) Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: ASCO Clinical Practice Guideline Focused Update. J Clin Oncol 37(5):423–438. https://doi.org/10.1200/jco.18.01160

    Article  CAS  Google Scholar 

  4. Pagani O, Regan MM, Walley BA, Fleming GF, Colleoni M, Láng I, Gomez HL, Tondini C, Burstein HJ, Perez EA, Ciruelos E, Stearns V, Bonnefoi HR, Martino S, Geyer CE, Pinotti G, Puglisi F, Crivellari D, Ruhstaller T, Winer EP, Rabaglio-Poretti M, Maibach R, Ruepp B, Giobbie-Hurder A, Price KN, Bernhard J, Luo W, Ribi K, Viale G, Coates AS, Gelber RD, Goldhirsch A, Francis PA (2014) Adjuvant exemestane with ovarian suppression in premenopausal breast cancer. J Clin Oncol 371(2):107–118. https://doi.org/10.1056/NEJMoa1404037

    Article  CAS  Google Scholar 

  5. Saha P, Regan MM, Pagani O, Francis PA, Walley BA, Ribi K, Bernhard J, Luo W, Gomez HL, Burstein HJ, Parmar V, Torres R, Stewart J, Bellet M, Perello A, Dane F, Moreira A, Vorobiof D, Nottage M, Price KN, Coates AS, Goldhirsch A, Gelber RD, Colleoni M, Fleming GF (2017) Treatment efficacy, adherence, and quality of life among women younger than 35 years in the International Breast Cancer Study Group TEXT and SOFT Adjuvant Endocrine Therapy Trials. J Clin Oncol 35(27):3113–3122. https://doi.org/10.1200/jco.2016.72.0946

    Article  CAS  Google Scholar 

  6. Ryden L, Heibert Arnlind M, Vitols S, Hoistad M, Ahlgren J (2016) Aromatase inhibitors alone or sequentially combined with tamoxifen in postmenopausal early breast cancer compared with tamoxifen or placebo—meta-analyses on efficacy and adverse events based on randomized clinical trials. Breast 26:106–114. https://doi.org/10.1016/j.breast.2016.01.006

    Article  Google Scholar 

  7. Goss PE, Ingle JN, Pritchard KI, Robert NJ, Muss H, Gralow J, Gelmon K, Whelan T, Strasser-Weippl K, Rubin S, Sturtz K, Wolff AC, Winer E, Hudis C, Stopeck A, Beck JT, Kaur JS, Whelan K, Tu D, Parulekar WR (2016) Extending aromatase-inhibitor adjuvant therapy to 10 years. NEJM 375(3):209–219. https://doi.org/10.1056/NEJMoa1604700

    Article  CAS  Google Scholar 

  8. Gandubert C, Carriere I, Escot C, Soulier M, Hermes A, Boulet P, Ritchie K, Chaudieu I (2009) Onset and relapse of psychiatric disorders following early breast cancer: a case–control study. Psychooncology 18(10):1029–1037. https://doi.org/10.1002/pon.1469

    Article  Google Scholar 

  9. Mayer M (2010) Lessons learned from the metastatic breast cancer community. Semin Oncol Nurs 26(3):195–202. https://doi.org/10.1016/j.soncn.2010.05.004

    Article  Google Scholar 

  10. Tsaras K, Papathanasiou IV, Mitsi D, Veneti A, Kelesi M, Zyga S, Fradelos EC (2018) Assessment of depression and anxiety in breast cancer patients: prevalence and associated factors. Asian Pac J Cancer Prev 19(6):1661–1669. https://doi.org/10.22034/apjcp.2018.19.6.1661

    Article  Google Scholar 

  11. Mehnert A, Koch U (2008) Psychological comorbidity and health-related quality of life and its association with awareness, utilization, and need for psychosocial support in a cancer register-based sample of long-term breast cancer survivors. J Psychosom Res 64(4):383–391. https://doi.org/10.1016/j.jpsychores.2007.12.005

    Article  Google Scholar 

  12. Mehnert A, Brahler E, Faller H, Harter M, Keller M, Schulz H, Wegscheider K, Weis J, Boehncke A, Hund B, Reuter K, Richard M, Sehner S, Sommerfeldt S, Szalai C, Wittchen HU, Koch U (2014) Four-week prevalence of mental disorders in patients with cancer across major tumor entities. J Clin Oncol 32(31):3540–3546. https://doi.org/10.1200/jco.2014.56.0086

    Article  Google Scholar 

  13. Haskins CB, McDowell BD, Carnahan RM, Fiedorowicz JG, Wallace RB, Smith BJ, Chrischilles EA (2019) Impact of preexisting mental illness on breast cancer endocrine therapy adherence. Breast Cancer Res Treat 174(1):197–208. https://doi.org/10.1007/s10549-018-5050-1

    Article  CAS  Google Scholar 

  14. Smith KL, Yeruva SLH, Blackford A, Huang CY, Westbrook KE, Harding BA, Smith A, Fetting J, Wolff AC, Jelovac D, Miller RS, Connolly R, Armstrong D, Nunes R, Visvanathan K, Stearns V (2018) Predictors of adherence to adjuvant endocrine therapy (ET) for early breast cancer (BC) in a prospective clinic-based cohort. Cancer Res 78(4). https://doi.org/10.1158/15387445.SABCS17-P3-12-02

  15. Bender CM, Gentry AL, Brufsky AM, Casillo FE, Cohen SM, Dailey MM, Donovan HS, Dunbar-Jacob J, Jankowitz RC, Rosenzweig MQ, Sherwood PR, Sereika SM (2014) Influence of patient and treatment factors on adherence to adjuvant endocrine therapy in breast cancer. Oncol Nurs Forum 41(3):274–285. https://doi.org/10.1188/14.onf.274-285

    Article  Google Scholar 

  16. Faller H, Strahl A, Richard M, Niehues C, Meng K (2017) Symptoms of depression and anxiety as predictors of physical functioning in breast cancer patients. A prospective study using path analysis. Acta Oncol 56(12):1677–1681. https://doi.org/10.1080/0284186x.2017.1333630

    Article  CAS  Google Scholar 

  17. Merriman JD, Sereika SM, Brufsky AM, McAuliffe PF, McGuire KP, Myers JS, Phillips ML, Ryan CM, Gentry AL, Jones LD, Bender CM (2017) Trajectories of self-reported cognitive function in postmenopausal women during adjuvant systemic therapy for breast cancer. Psycho-oncology 26(1):44–52. https://doi.org/10.1002/pon.4009

    Article  Google Scholar 

  18. Lidgren M, Wilking N, Jönsson B, Rehnberg C (2007) Health related quality of life in different states of breast cancer. Qual Life Res 16(6):1073–1081. https://doi.org/10.1007/s11136-007-9202-8

    Article  Google Scholar 

  19. Chow S, Wan BA, Pidduck W, Zhang L, DeAngelis C, Chan S, Yee C, Drost L, Leung E, Sousa P, Lewis D, Lam H, Chow R, Lock M, Chow E (2019) Symptoms predictive of overall quality of life using the Edmonton Symptom Assessment Scale in breast cancer patients receiving radiotherapy. Clin Breast Cancer 19(6):405–410. https://doi.org/10.1016/j.clbc.2019.05.007

    Article  Google Scholar 

  20. Sun H, Huang H, Ji S, Chen X, Xu Y, Zhu F, Wu J (2019) The efficacy of cognitive behavioral therapy to treat depression and anxiety and improve quality of life among early-stage breast cancer patients. Integr Cancer Ther. https://doi.org/10.1177/1534735419829573

    Article  Google Scholar 

  21. Ye M, Du K, Zhou J, Zhou Q, Shou M, Hu B, Jiang P, Dong N, He L, Liang S, Yu C, Zhang J, Ding Z, Liu Z (2018) A meta-analysis of the efficacy of cognitive behavior therapy on quality of life and psychological health of breast cancer survivors and patients. Psycho-oncology 27(7):1695–1703. https://doi.org/10.1002/pon.4687

    Article  Google Scholar 

  22. Andersen BL, DeRubeis RJ, Berman BS, Gruman J, Champion VL, Massie MJ, Holland JC, Partridge AH, Bak K, Somerfield MR, Rowland JH (2014) Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol 32(15):1605–1619. https://doi.org/10.1200/jco.2013.52.4611

    Article  Google Scholar 

  23. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, Widen RH, Fitzgerald SG, Shelton MM, Barta M, Goodman M, Cox CE, Kip KE (2009) Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psycho-Oncology 18(12):1261–1272. https://doi.org/10.1002/pon.1529

    Article  Google Scholar 

  24. Wurtzen H, Dalton SO, Elsass P, Sumbundu AD, Steding-Jensen M, Karlsen RV, Andersen KK, Flyger HL, Pedersen AE, Johansen C (2013) Mindfulness significantly reduces self-reported levels of anxiety and depression: results of a randomised controlled trial among 336 Danish women treated for stage I–III breast cancer. Eur J Cancer 49(6):1365–1373. https://doi.org/10.1016/j.ejca.2012.10.030

    Article  Google Scholar 

  25. Greenlee H, DuPont-Reyes MJ, Balneaves LG, Carlson LE, Cohen MR, Deng G, Johnson JA, Mumber M, Seely D, Zick SM, Boyce LM, Tripathy D (2017) Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin 67(3):194–232. https://doi.org/10.3322/caac.21397

    Article  Google Scholar 

  26. Lyman GH, Greenlee H, Bohlke K, Bao T, DeMichele AM, Deng GE, Fouladbakhsh JM, Gil B, Hershman DL, Mansfield S, Mussallem DM, Mustian KM, Price E, Rafte S, Cohen L (2018) Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. J Clin Oncol 36(25):2647–2655. https://doi.org/10.1200/jco.2018.79.2721

    Article  CAS  Google Scholar 

  27. Thekdi SM, Trinidad A, Roth A (2014) Psychopharmacology in cancer. Curr Psychiatry Rep 17(1):529. https://doi.org/10.1007/s11920-014-0529-x

    Article  Google Scholar 

  28. Hopwood P, Howell A, Maguire P (1991) Screening for psychiatric morbidity in patients with advanced breast cancer: validation of two self-report questionnaires. Br J Cancer 64(2):353–356

    Article  CAS  Google Scholar 

  29. Polanski J, Chabowski M, Chudiak A, Uchmanowicz B, Janczak D, Rosinczuk J, Mazur G (2018) Intensity of anxiety and depression in patients with lung cancer in relation to quality of life. Adv Exp Med Biol 1023:29–36. https://doi.org/10.1007/5584_2017_50

    Article  CAS  Google Scholar 

  30. Jung JY, Lee JM, Kim MS, Shim YM, Zo JI, Yun YH (2017) Comparison of fatigue, depression, and anxiety as factors affecting posttreatment health-related quality of life in lung cancer survivors. Psychooncology. https://doi.org/10.1002/pon.4513

    Article  Google Scholar 

  31. Deimling GT, Kahana B, Bowman KF, Schaeffer ML (2002) Cancer survivorship and psychological distress in later life. Psycho-Oncology 11(6):479–494. https://doi.org/10.1002/pon.614

    Article  Google Scholar 

  32. Greer JA, Solis JM, Temel JS, Lennes IT, Prigerson HG, Maciejewski PK, Pirl WF (2011) Anxiety disorders in long-term survivors of adult cancers. Psychosomatics 52(5):417–423. https://doi.org/10.1016/j.psym.2011.01.014

    Article  Google Scholar 

  33. Moadel A, Kolidas E, Ghavamian R (2016) Psychosocial needs assessment of underserved prostate cancer patients: survivorship program planning. J Clin Oncol 34(15_suppl):10107

    Article  Google Scholar 

  34. Mosher CE, DuHamel KN (2012) An examination of distress, sleep, and fatigue in metastatic breast cancer patients. Psycho-Oncology 21(1):100–107. https://doi.org/10.1002/pon.1873

    Article  Google Scholar 

  35. Hughes KL, Sargeant H, Hawkes AL (2011) Acceptability of the distress thermometer and problem list to community-based telephone cancer helpline operators, and to cancer patients and carers. BMC Cancer 11(46). https://doi.org/10.1186/1471-2407-11-46

  36. Verdonck-De Leeuw I, Krebber AM, Cuijpers P, De Bree R, Leemans CR (2013) Benefits and costs of screening in clinical practice to identify head and neck cancer patients with untreated psychological distress after treatment. Psycho-Oncology 22:49. https://doi.org/10.1111/j.1099-1611.2013.3393

    Article  Google Scholar 

  37. Burgoyne MJ, Bingen K, Leuck J, Dasgupta M, Ryan P, Hoffmann RG (2015) Cancer-related distress in young adults compared to middle-aged and senior adults. J Adolesc Young Adult Oncol 4(2):56–63. https://doi.org/10.1089/jayao.2014.0005

    Article  Google Scholar 

  38. Rose JH, O’Toole EE, Einstadter D, Love TE, Shenko CA, Dawson NV (2008) Patient age, well-being, perspectives, and care practices in the early treatment phase for late-stage cancer. J Gerontol A Biol Sci Med Sci 63(9):960–968

    Article  Google Scholar 

  39. Linden W, Vodermaier A, Mackenzie R, Greig D (2012) Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age. J Affect Disord 141(2–3):343–351. https://doi.org/10.1016/j.jad.2012.03.025

    Article  Google Scholar 

  40. Jensen RE, Potosky AL, Moinpour CM, Lobo T, Cella D, Hahn EA, Thissen D, Smith AW, Ahn J, Luta G, Reeve BB (2017) United States population-based estimates of patient-reported outcomes measurement information system symptom and functional status reference values for individuals with cancer. J Clin Oncol 35(17):1913–1920. https://doi.org/10.1200/jco.2016.71.4410

    Article  Google Scholar 

  41. Alcala HE (2014) Differential mental health impact of cancer across racial/ethnic groups: findings from a population-based study in California. BMC Public Health 14:930. https://doi.org/10.1186/1471-2458-14-930

    Article  Google Scholar 

  42. Apenteng BA, Hansen AR, Opoku ST, Mase WA (2016) Racial disparities in emotional distress among cancer survivors: insights from the Health Information National Trends Survey (HINTS). J Cancer Educ 32(3):556–565. https://doi.org/10.1007/s13187-016-0984-7

    Article  Google Scholar 

  43. Grassi L, Caruso R, Sabato S, Massarenti S, Nanni MG, the UniFe Psychiatry Working Group Coauthors (2015) Psychosocial screening and assessment in oncology and palliative care settings. Front Psychol 5(1485). https://doi.org/10.3389/fpsyg.2014.01485

  44. Pachana NA, Byrne GJ, Siddle H, Koloski N, Harley E, Arnold E (2007) Development and validation of the Geriatric Anxiety Inventory. Int Psychogeriatr 19(1):103–114. https://doi.org/10.1017/s1041610206003504

    Article  Google Scholar 

  45. Brown LF, Kroenke K, Theobald DE, Wu J, Tu W (2010) The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain. Psychooncology 19(7):734–741. https://doi.org/10.1002/pon.1627

    Article  Google Scholar 

  46. Wilson KG, Chochinov HM, Skirko MG, Allard P, Chary S, Gagnon PR, Macmillan K, De Luca M, O’Shea F, Kuhl D, Fainsinger RL, Clinch JJ (2007) Depression and anxiety disorders in palliative cancer care. J Pain Symptom Manag 33(2):118–129. https://doi.org/10.1016/j.jpainsymman.2006.07.016

    Article  Google Scholar 

  47. Xiao F, Song X, Chen Q, Dai Y, Xu R, Qiu C, Guo Q (2017) Effectiveness of psychological interventions on depression in patients after breast cancer surgery: a meta-analysis of randomized controlled trials. Clin Breast Cancer 17(3):171–179. https://doi.org/10.1016/j.clbc.2016.11.003

    Article  Google Scholar 

  48. Schellekens MPJ, van den Hurk DGM, Prins JB, Donders ART, Molema J, Dekhuijzen R, van der Drift MA, Speckens AEM (2017) Mindfulness-based stress reduction added to care as usual for lung cancer patients and/or their partners: a multicentre randomized controlled trial. Psycho-oncology 26(12):2118–2126. https://doi.org/10.1002/pon.4430

    Article  CAS  Google Scholar 

  49. Bisseling EM, Schellekens MPJ, Jansen ETM, van Laarhoven HWM, Prins JB, Speckens AEM (2017) Mindfulness-based stress reduction for breast cancer patients: a mixed method study on what patients experience as a suitable stage to participate. Support Care Cancer 25(10):3067–3074. https://doi.org/10.1007/s00520-017-3714-8

    Article  Google Scholar 

  50. Kenne Sarenmalm E, Mårtensson LB, Andersson BA, Karlsson P, Bergh I (2017) Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med 6(5):1108–1122. https://doi.org/10.1002/cam4.1052

    Article  CAS  Google Scholar 

  51. Carlson LE, Angen M, Cullum J, Goodey E, Koopmans J, Lamont L, MacRae JH, Martin M, Pelletier G, Robinson J, Simpson JS, Speca M, Tillotson L, Bultz BD (2004) High levels of untreated distress and fatigue in cancer patients. Br J Cancer 90(12):2297–2304. https://doi.org/10.1038/sj.bjc.6601887

    Article  CAS  Google Scholar 

  52. Horneber M, Bueschel G, Dennert G, Less D, Ritter E, Zwahlen M (2012) How many cancer patients use complementary and alternative medicine: a systematic review and meta-analysis. Integr Cancer Ther 11(3):187–203. https://doi.org/10.1177/1534735411423920

    Article  Google Scholar 

  53. Link AR, Gammon MD, Jacobson JS, Abrahamson P, Bradshaw PT, Terry MB, Teitelbaum S, Neugut A, Greenlee H (2013) Use of self-care and practitioner-based forms of complementary and alternative medicine before and after a diagnosis of breast cancer. Evid Based Complement Altern Med. https://doi.org/10.1155/2013/301549

    Article  Google Scholar 

  54. Greenlee H, Kwan ML, Ergas IJ, Sherman KJ, Krathwohl SE, Bonnell C, Lee MM, Kushi LH (2009) Complementary and alternative therapy use before and after breast cancer diagnosis: the Pathways Study. Breast Cancer Res Treat 117(3):653–665. https://doi.org/10.1007/s10549-009-0315-3

    Article  Google Scholar 

  55. Winter RW, Korzenik JR (2017) The practical pros and cons of complementary and alternative medicine in practice: integrating complementary and alternative medicine into clinical care. Gastroenterol Clin N Am 46(4):907–916. https://doi.org/10.1016/j.gtc.2017.08.013

    Article  Google Scholar 

  56. Nahin RL, Barnes PM, Stussman BJ (2016) Insurance coverage for complementary health approaches among adult users: United States, 2002 and 2012. NCHS Data Brief 235:1–8

    Google Scholar 

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Funding

This research is funded in part by Grants from the National Cancer Institute/National Institutes of Health (R01 CA158243, P30-CA008748), and the Translational Research and Integrative Medicine Fund at the Memorial Sloan Kettering Cancer Center, and the National Institute on Aging/National Institutes of Health and American Federation for Aging Research (Trevino, K23AG048632). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

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  1. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Kelly M. Trevino, Neil Iyengar, Qing Li & Jun J. Mao

  2. 641 Lexington Ave., 7th Floor, New York, NY, 10065, USA

    Kelly M. Trevino

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Correspondence to Kelly M. Trevino.

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Dr. Iyengar reported receiving personal fees from Novartis outside the submitted work. All other authors have no conflicts of interest to disclose.

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Trevino, K.M., Iyengar, N., Li, Q. et al. Receipt of psychological counseling and integrative medicine services among breast cancer survivors with anxiety. Breast Cancer Res Treat 184, 301–310 (2020). https://doi.org/10.1007/s10549-020-05859-0

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